This study aimed to comprehensively examine the association of gallstones, cholecystectomy, and cancer risk. Multivariable logistic regressions were performed to estimate the observational associations of gallstones and cholecystectomy with cancer risk, using data from a nationwide cohort involving 239 799 participants. General and gender-specific two-sample Mendelian randomization (MR) analysis was further conducted to assess the causalities of the observed associations. Observationally, a history of gallstones without cholecystectomy was associated with a high risk of stomach cancer (adjusted odds ratio (aOR)=2.54, 95% confidence interval (CI) 1.50-4.28), liver and bile duct cancer (aOR=2.46, 95% CI 1.17-5.16), kidney cancer (aOR=2.04, 95% CI 1.05-3.94), and bladder cancer (aOR=2.23, 95% CI 1.01-5.13) in the general population, as well as cervical cancer (aOR=1.69, 95% CI 1.12-2.56) in women. Moreover, cholecystectomy was associated with high odds of stomach cancer (aOR=2.41, 95% CI 1.29-4.49), colorectal cancer (aOR=1.83, 95% CI 1.18-2.85), and cancer of liver and bile duct (aOR=2.58, 95% CI 1.11-6.02). MR analysis only supported the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer. This study added evidence to the causal effect of gallstones on stomach, liver and bile duct, kidney, and bladder cancer, highlighting the importance of cancer screening in individuals with gallstones.
Humans ; Mendelian Randomization Analysis ; Gallstones/complications* ; Female ; Male ; Cholecystectomy/statistics & numerical data* ; Middle Aged ; Risk Factors ; Aged ; Adult ; Neoplasms/etiology* ; Stomach Neoplasms/epidemiology*

Background/Aims: Low educational attainment is a well-established risk factor for nonalcoholic fatty liver disease (NAFLD) in developed areas. However, the association between educational attainment and the risk of NAFLD is less clear in China. Methods: A cross-sectional study including over 200,000 Chinese adults across mainland China was conducted. Information on education level and lifestyle factors were obtained through standard questionnaires, while NAFLD and advanced fibrosis were diagnosed using validated formulas. Outcomes included the risk of NAFLD in the general population and high probability of fibrosis among patients with NAFLD. Logistic regression analysis was employed to estimate the risk of NAFLD and fibrosis across education levels. A causal mediation model was used to explore the potential mediators. Results: Comparing with those receiving primary school education, the multi-adjusted odds ratios (95% confidence intervals) for NAFLD were 1.28 (1.16 to 1.41) for men and 0.94 (0.89 to 0.99) for women with college education after accounting for body mass index. When considering waist circumference, the odds ratios (95% CIs) were 0.94 (0.86 to 1.04) for men and 0.88 (0.80 to 0.97) for women, respectively. The proportions mediated by general and central obesity were 51.00% and 68.04% for men, while for women the proportions were 48.58% and 32.58%, respectively. Furthermore, NAFLD patients with lower educational attainment showed an incremental increased risk of advanced fibrosis in both genders. Conclusions In China, a low education level was associated with a higher risk of prevalent NAFLD in women, as well as high probability of fibrosis in both genders.

Objective:To construct the evaluation system of Intensive Care Unit (ICU) practice base for master of nursing specialist.Methods:The evaluation indicators at all levels were initially formulated through literature review and semi-structured interviews. Using the sampling method, 25 experts were selected from August to October 2021 for correspondence. The evaluation system of ICU practice base for master of nursing specialist was finally determined by Delphi method and analytic hierarchy process.Results:A total of two rounds of consultation were conducted. The expert positive coefficients were 88% (22/25) and 91% (20/22), the expert authority coefficients were 0.953 and 0.948, and the Kendall's W were 0.211 and 0.210 respectively with statistical differences ( P<0.01). The final evaluation system of ICU practice base for master of nursing specialist included 4 first-level indicators, 15 second-level indicators and 103 third-level indicators and evaluation contents. Conclusions:The evaluation system of ICU practice base for master of nursing specialist is scientific, reliable and comprehensive, which can provide reference for formulating the evaluation criteria of clinical practice base for nursing graduate students.

Objective:To investigate vision-related quality of life, anxiety and depression in patients with primary angle-closure glaucoma (PACG) and the influencing factors in Baotou, Inner Mongolia.Methods:A cross-sectional study was conducted.One hundred and eighty-two consecutive PACG patients (364 eyes) with intraocular pressure ≤20 mmHg (1 mmHg=0.133 kPa) at 3 random times after treatment were enrolled in Baotou Chaoju Ophthalmic Hospital from September 2018 to January 2020.Gender, age, marital status, education level, monthly income, total treatment cost, glaucoma treatment time, surgery and drug treatment history, best corrected visual acuity (BCVA), Humphrey visual field index (VFI) and scores of the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and Hospital Anxiety and Depression Scale (HADS) of patients were recorded.Pearson correlation analysis was used to analyze the correlation between age and composite VFQ-25 score.Spearman rank correlation analysis was used to analyze the correlation between other statistical data.Stepwise multivariate linear regression was used to analyze the correlation between composite VFQ-25 score, HADS score and statistically significant influencing factors above.This study protocol adhered to the Declaration of Helsinki, and was approved by an Ethics Committee of Beijing Tongren Hospital, Capital Medical University (No.TRECKY2015-30). Written informed consent was obtained from each subject.Results:The mean age of subjects was (59.75±8.43) years.The mean composite VFQ-25 score was (68.59±14.43) points.The mean HADS, HADS-Anxiety (HADS-A) and HADS-Depression (HADS-D) scores were 16.00 (12.00, 20.00), 8.00 (6.00, 10.00), 8.00 (6.00, 10.00) points, respectively.The proportion of anxious (HADS-A score>10 points) and depressd (HADS-D score >10 points) patients was 18.1% (33/182) and 13.7% (25/182), respectively.Age was positively correlated with BCVA in eyes with better and worse vision ( rs=0.36, 0.29; both at P<0.01), and it was negatively correlated with mean deviation (MD) of Humphrey visual field in the better-MD and worse-MD eyes, VFI of Humphrey visual field in the better-VFI and worse-VFI eyes ( rs=-0.21, -0.23, -0.30, -0.23; all at P<0.01). The composite VFQ-25 score was negatively correlated with age, BCVA in the eyes with better and worse vision ( rs=-0.32, -0.34, -0.48; all at P<0.01), and it was positively correlated with MD in the better-MD and worse-MD eyes, VFI in the better-VFI and worse-VFI eyes ( rs=0.37, 0.45, 0.38, 0.46; all at P<0.01). The HADS-A score was negatively correlated with MD in the better-MD eye ( rs=-0.20, P<0.01). The HADS-D score was positively correlated with BCVA in the eyes with worse vision ( rs=0.26, P<0.01) and negatively correlated with MD in the better-MD and worse-MD eyes, and VFI in the worse-VFI eyes ( rs=-0.21, -0.22, -0.22; all at P<0.01). The HADS score was positively correlated with BCVA in the eyes with worse vision ( rs=0.22, P<0.01), and negatively correlated with MD in the better-MD and worse-MD eyes, and VFI in the worse-VFI eyes ( rs=-0.20, -0.20, -0.21; all at P<0.01). The composite VFQ-25 score was negatively correlated with mean HADS-A, HADS-D and HADS scores ( rs=-0.41, -0.41, -0.45; all at P<0.01). According to the multivariate analysis, the composite VFQ-25 score was related to age ( P<0.01), education level ( P<0.01), total treatment cost ( P<0.05), BCVA in the eyes with better vision ( P<0.05) and MD in the worse-MD eyes ( P<0.01). The HADS score was related to gender ( P<0.05) and the composite VFQ-25 score ( P<0.01). Conclusions:The vision-related quality of life and incidence of anxiety and depression are low in patients with PACG in Baotou region, Inner Mongolia.With age increasing, PACG patients suffer from declined visual function, increased visual field damage, reduced vision-related quality of life and raised anxiety and depression.The vision-related quality of life is poorer in patients with lower education level and higher total treatment cost.Female glaucoma patients are more likely to suffer from anxiety and depression.

Objective? To explore how to apply best practice guideline in teaching and the initial effects. Methods? After deeply investigating courses, this study selected best practice guideline by combining with existing problems in teaching. Combined with the first-level and second-level class, a careful design scheme was conducted by each course groups and multiple rounds of project argumentation. After determining the program and teaching resources, each guideline application course group began to fully implement according to their own program. Results? The best practice guidelines were successfully applied in 7 courses through various teaching forms including situation simulation, flipped classroom, case teaching as well as role playing which played an positive role in teaching content, teaching design and teaching evaluation. Conclusions? In the whole process of implementation, teachers and students feel that the application of best practice guideline in nursing teaching is helpful to expand the frontier content of teaching, establish the evidence-based concept of teachers and students and initially cultivate critical thinking. It also plays a positive role in arousing the enthusiasm of nursing students and the comprehensive application of the knowledge they have learned. It makes evaluation methods flexible and diversified and is also beneficial to the real and objective response to the learning effect of nursing students.

OBJECTIVE To investigate the effect of diallyl sulfide (DAS) in protection against acute lung injury in rats induced by paraquat(PQ). METHODS A total of 100 male Wistar rats were randomly divided into normal control group,PQ 70 mg·kg-1 model group,and DAS 25,50 and 100 mg·kg-1 treatment groups,with 20 rats in each group. A poisoning model was estalolished after administration ig at a single dose of PQ 70 mg·kg-1,while the normal control group was ip given the same volume of normal saline. DAS 25,50 and 100 mg · kg-1 was intraperitoneally injected 30 min before and after PQ exposure. Five rats in each group were sacrificed at 1,3,6 and 12 h,respectively. The inferior lobe of the right lung was observed by HE staining under an optical microscope. Tissue of the upper lobe of the right lung was used to detect the content of nitric oxide (NO). Alveolar macrophages (AMs) were collected and cultured for 24 h,and the content of nitric oxide synthase(iNOS)in the supernatant was detected. AMs were cultured for 72 h and the expression of iNOS protein in AMs was detected by immunocytochemistry method. RESULTS Compared with normal control group,the alveolar structure of PQ group was severely damaged and the pathological score was significantly increased(P<0.01). The NO content of PQ group was significantly higher than in normal control group(P<0.01). The content and protein expression of iNOS were significantly increased in PQ group(P<0.01). Compared with PQ group,the lung injury score of rats in DAS 50 mg·kg-1 group at 3,6 and 12 h and in the DAS 100 mg·kg-1 group at each time point was decreased(P<0.05). Compared with PQ group,the NO content of DAS 25 and 50 mg · kg-1 group was decreased(P<0.05),and the NO content of DAS 100 mg · kg-1 group was significantly reduced(P<0.01). The content of iNOS was reduced in DAS 100 mg · kg-1 group(P<0.05). Compared with PQ group,the expression of iNOS protein in DAS groups was decreased(P<0.05). CONCLUSION DAS can inhibit the oxidative damage in rats induced by PQ.

Objective To investigate the effects of methycobal on the expression of Caspase-3 in brain tissue after cerebral ischemia reperfusion in rats. Methods Rats were randomly divided into sham-operation group, model control group, nimodipine group and low-dose methycobal group, high-dose methycobal group(n=30 in each group).Rats in the sham-operation group and model control group were administered intragastrically with 0.9% sodium chloride solution, rats in the nimodipine group were treated with 1 mg . kg-1 . d-1 of nimodipine, rats in the low- and high-dose of methycobal groups were given 50 and 100 μg.kg-1 .d-1 of methycobal, respectively. The rat model of cerebral ischemia reperfusion was established by middle cerebral artery occlusion with suture method for 3 h.Neurological deficit scores were evaluated 24 h after reperfusion.The apoptosis of perifocal cortex cells was detected by TUNEL method and the expression of Caspase-3 was analyzed by RT-PCR 6, 12 and 24 h after reperfusion. Results Neurological deficit scores in model control group, nimodipine group, low-dose methycobal group and high-dose methycobal group were 2.70±0.52, 1.30±0.51, 2.20±0.75 and 1.30±0.81, respectively.Compared with model control group, neurological deficit scores were significantly different in the nimodipine group, low-dose methycobal group and high-dose methycobal group(P<0.05 or P<0.01).There were no significant differences between the high-dose methycobal group and nimodipine group ( P>0. 05 ) . There was a significant difference between the high-dose methycobal group and low-dose methycobal group( P<0. 05 ) . The results of apoptosis by TUNEL were as follows: compared with model control group, the apoptosis decreased obvsiouly in the nimodipine group, low-dose methycobal group, and high-dose methycobal group at each time point.There was significant difference between the high-dose methycobal group and nimodipine group at the end of the 24th hours (P<0.01).Compared with low-dose methycobal group, there were significant differences in the high-dose methycobal group at the end of 6th, 12th and 24th hours(P<0.01 or P<0.05).The results of RT-PCR were as follows: there was expression of caspase-3 mRNA in the perifocal cortex of all groups, with weak expression in the sham-operation group.Compared with the sham-operation group, the expression of caspase-3 mRNA was increased significantly in the model control group(P<0.01).The expression of caspase-3 mRNA was reduced significantly in the nimodipine group, the low-dose methycobal group and high-dose methycobal group as compared with model control group at each time point( P<0.05 or P<0.01) , but it was not significantly different in the low-dose methycobal group and high-dose methycobal group as compared with that of the nimodipine group(P>0.05).There were significant differences between the high-dose methycobal group and low-dose methycobal group at the end of 24 h(P<0.05). Conclusion Methycobal can protect the brain cells from injury after cerebral ischemia reperfusion by adjusting the expression of Caspase-3m RNA, and the high-dose methycobal is more effective.

Objective To evaluate the effect of lappaconitine on renal ischemia-reperfusion (I/R) injury in mice.Methods Thirty-six male Wistar rats,weighing 180-220 g,were randomly divided into 3 groups (n=12 each) using a random number table:sham operation group (group S),group I/R and lappaconitine group (group LA).Renal I/R was induced by occlusion of the left renal pedicle for 45 min with atraumatic microclips followed by reperfusion,and the right kidney was removed after atraumatic microclips were released.At 30 min before reperfusion,lappaconitine 4 mg/kg was injected intraperitoneally in group LA,and normal saline 2 ml was given in S and I/R groups.In group S,the left renal pedicle was only isolated.At 5 and 24 h of reperfusion,blood samples were taken from the inferior vena cava for determination of serum creatinine (Cr) and blood urea nitrogen (BUN) concentrations,and kidney specimens were obtained for histopathologic examination (with light microscope) and for determination of the expression of cyclooxygenase-2 (COX-2) and matrix metalloproteinase-2 (MMP-2) in renal tissues (by immunohistochemistry).Results Compared with group S,the serum Cr and BUN concentrations were significantly increased,and the expression of COX-2 and MMP-2 in renal tissues was up-regulated at 5 and 24 h of reperfusion in I/R and LA groups.Compared with group I/R,the serum Cr and BUN concentrations were significantly decreased,the expression of COX-2 and MMP-2 in renal tissues was down-regulated at 5 and 24 h of reperfusion and histopathologic changes were reduced in group LA.Conclusion Lappaconitine can attenuate renal I/R injury through inhibiting the expression of COX-2 and MMP-2 in rats.

Objective To evaluate the effects of sinomenine on the expression of hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor (VEGF) during renal ischemia-reperfusion (I/ R) in rats.Methods Fifty-four male Wistar rats, weighing 180-220 g, were randomly divided into 3 groups (n=18 each) using a random number table: sham operation group (group S) , group I/R and sinomenine group (group SIN).Renal I/R was induced by clamping the left renal pedicle for 45 min followed by reperfusion in I/R and SIN groups.In group S, the bilateral renal pedicels were only exposed.Sinomenine 60 mg/kg was intraperitoneally injected at 30 min before reperfusion in group SIN, while the equal volume of normal saline was given in group S and group I/R.At 6, 12 and 24 h (T1-3) of reperfusion, 6 rats from each group were chosen, and blood samples were drawn from the hearts for determination of the serum creatinine (Cr) and blood urea nitrogen (BUN) concentrations.The animals were then sacrificed, and the left kidney was removed and embedded into a paraffin block for determination of the expression of HIF-1α and VEGF in the renal tissues (by immuno-histochemistry).Results Compared with group S, the serum Cr and BUN concentrations were significantly increased at T1-3 , and the expression of HIF-1α was significantly up-regulated at T2,3 in group I/R and group SIN, and the expression of VEGF was significantly upregulated at T2,3in group I/R, and at T1-3 in group SIN.Compared with group I/R, the serum Cr concentration at T1-3 and serum BUN concentration at T2,3 were significantly decreased and the expression of HIF-1α at T2,3and VEGF at T1-3was significantly up-regulated in group SIN.Conclusion The mechanism by which sinomenine attenuates renal I/R injury is related to up-regulation of the expression of HIF-1α and VEGF in the renal tissues of rats.